Florence Nightingale

NUR 3006
*****
Religious inspiration
called her to focus on
the health of the
masses
 Florence Nightingale
 Began her nursing training in 1851 in
Germany
 Pioneered the concept of formal nursing
education
 Her experience in treating sick/injured
soldiers in the Crimean War strongly
influenced her philosophy of nursing
 First to use statistics to guide care delivery
 Florence Nightingale…
“All sciences of observation depend
upon statistical methods—without
these, are blind empiricism. Make your
facts comparable before deducing
causes. Incomplete, pell-mell
observations arranged so as to support
theory; insufficient number of
observations; this is what one sees.”

Source: Florence Nightingale: Mystic, Visionary, Healer (B.M. Dossey), p. 230.

 Florence Nightingale
 Based her ideas on individual, societal, and
professional values
 Her strongest influence was
education, observation, and
hands-on experience
 She formulated her values
through years of working
with charities, hospitals,
& the military
 Florence Nightingale
 In 1860 Nightingale published Notes on
Nursing
 Considered the first “nursing theorist”
 Information on her theory has been
obtained through interpretation of her
writings
 Her theory significantly influenced 3 other
groups of theories - Adaptation Theory,
Need Theory, & Stress Theory
Nightingale’s Notes on Nursing:

 Was not written as a nursing text

 Was a guide to help organize & manipulate
the environment for persons requiring
nursing care
 Nightingale originally wanted women to
teach themselves to nurse and viewed
Notes on Nursing as “hints” to enable
them to do so
Nightingale on Notes on Nursing…
“I thank you sincerely & kindly for what you
have to say about my Notes on Nursing —
you do not know how, in the midst of much
disappointment, such words cheer &
strengthen us. The only possible merit of
my little book is that there is not a word in it
written for the sake of writing, but only
forced out of me by much experience in
human suffering.”

Source: Florence Nightingale: Mystic, Visionary, Healer (B.M. Dossey), p. 231.

Nightingale’s Nursing Theory
 The first published nursing theory (1860)
 Persons are in relation with the environment
 Stresses the healing properties of the
physical environment (fresh air, light,
warmth, and cleanliness)
 Nursing puts patients in the “best conditions”
for nature to act upon them
 Health is “the positive of which the pathology
is the negative”
 “Nature alone cures”
 Nightingale’s Nursing Theory
 When aspects of the environment are out
of balance, the client must use energy to
counter these environmental stresses
 Stresses drain the client of the energy
needed for healing
 Viewed disease as a reparative process
 The health of the home/community are
critical components in an individual’s health
 Nightingale’s Nursing Theory
 Theory basis: the inter-relationship of a
healthful environment with nursing
 External influences and conditions can
prevent, suppress, or contribute to disease or
death
 Theory goal: Nurses help patients retain
their own vitality by meeting their basic
needs through control of the environment
 Nursing’s Focus: control of the
environment for individuals, families & the
community
Three Types of Environments

 Physical
 Psychological
 Social
 Physical Environment
 Consists of physical elements where the
patient is being treated
 Affects all other aspects of the environment
 Cleanliness of environment relates directly to
disease prevention and patient mortality
 Aspects of the physical environment
influence the social and psychological
environments of the person
 Psychological Environment
 Can be affected by a negative physical
environment which then causes STRESS
 Requires various activities to keep the
mind active (i.e, manual work, appealing
food, a pleasing environment)
 Involves communication with the person,
about the person, and about other people
 communication should be therapeutic,
soothing, & unhurried!
 Social Environment
 Involves collecting data about illness and
disease prevention
 Includes components of the physical
environment - clean air, clean water,
proper drainage
 Consists of a person’s home or hospital
room, as well as the total community that
affects the patient’s specific environment
 5 Major Components of a
Healthful Environmental

1. Proper ventilation
2. Adequate light
3. Sufficient warmth
4. Control of noise
5. Control of effluvia (noxious odors)
 Components of Nightingale’s
Environmental Theory:
 Health of Houses  Personal Cleanliness
 Ventilation and  Nutrition and Taking
Warming Food
 Light  Chattering Hopes and
 Noise Advices
 Variety  Observation of the
 Bed and Bedding Sick
 Social Considerations
 Cleanliness of Rooms
and Walls
Nightingale’s Theory & Nursing’s
Metaparadigm - PERSON
 Referred to by Nightingale as “the patient”
 A human being acted upon by a nurse, or
affected by the environment
 Has reparative powers to deal with disease
 Recovery is in the patient’s power as long
as a safe environment exists
Nightingale’s Theory & Nursing’s
Metaparadigm - ENVIRONMENT
 The foundational component of
Nightingale’s theory
 The external conditions & forces that affect
one’s life and development
 Includes everything from a person’s food
to a nurse’s verbal & nonverbal
interactions with the patient
Nightingale’s Theory & Nursing’s
Metaparadigm - HEALTH
 Maintained by using a person’s healing powers to
their fullest extent
 Maintained by controlling the environmental factors
so as to prevent disease
 Disease is viewed as a reparative process instituted
by nature
 Health & disease are the focus of the nurse
 Nurses help patients through their healing
process
Nightingale’s Theory & Nursing’s
Metaparadigm - NURSING
 Provides fresh air, light, warmth,
cleanliness, quiet, and a proper diet
 Facilitates a patient’s reparative process by
ensuring the best possible environment
 Influences the environment to affect health
 Supports the nursing process (even though
it was not even developed yet!)
Nightingale’s Theory & Nursing’s
Metaparadigm - NURSING
 Nursing education belongs in the
hands of nurses!
 Nursing is a discipline distinct
from medicine focusing on the
patient’s reparative process rather
than on their disease!!
 Critical Thinking Exercise
 Complete an environmental assessment of this
learning environment. Develop a plan for repair
or maintenance.
 Consider a patient you have recently cared for.
Identify areas of the environment that
Nightingale’s theory guides you to assess. Did
you consider these before in your own model of
practice?
 *****

 Using Nightingale’s model, compare and

contract the practice of nursing in the late 1800’s
with nursing in present times.
 Nightingale Resources
 On-line Florence Connection
 Florence Nightingale Museum
 Her Gravesite, Website
 Interesting Stories
 Collection of Her Letters
 Her Impact on Rural Hygiene